Comparison of Oral Care Solutions on Oral Microbial Colonization in Neurosurgical ICU Patients

Harran University

Status: Completed

Conditions: Oral Care

Treatments: Drug: Chlorhexidine gluconate (CHG); Drug: Sodium Bicarbonate (NaHCO3); Other: Apple Cider Vinegar

Study type: Interventional

Funder types: Other

Identifiers

NCT07365956

HarranU-MTAMER-001

Details and patient eligibility

About

In the high-stakes environment of the Neurosurgery Intensive Care Unit (NSICU), patient stability extends beyond neurological monitors and intracranial pressure readings. A critical yet often underemphasized front line of defense is oral health. Neurosurgery patients, frequently intubated, on mechanical ventilation, or with depressed consciousness, are at extreme risk for Ventilator-Associated Pneumonia (VAP) and systemic infections. Pathogenic oral microbiota can be aspirated into the lower respiratory tract, triggering such complications. Consequently, rigorous oral care is not merely a comfort measure but a vital infection control protocol. This article examines and compares the effects of three agents-Chlorhexidine Gluconate (CHG), Sodium Bicarbonate, and Apple Cider Vinegar (ACV)-on oral microbial colonization in this vulnerable population.

Full description

The normal oral flora undergoes a dramatic shift in critically ill patients. Factors like mouth breathing, nil-by-mouth status, decreased salivary flow, and the presence of endotracheal tubes create a pathogenic-friendly environment. This dysbiosis leads to colonization by opportunistic pathogens like Staphylococcus aureus, Pseudomonas aeruginosa, and Candida species. For neurosurgery patients, an ensuing pneumonia can lead to sepsis, increased intracranial pressure from systemic inflammation, prolonged ventilation, and longer ICU stays, directly impacting neurological recovery.

Aim of this study to examine the effect of oral care using ACV, chlorhexidine gluconate and sodium bicarbonate on oral microbial colonization in neurosurgery intensive care patients.

Enrollment: 90 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Mechanical ventilation was initiated less than 24 hours ago,
• Aged 18 years or older,
• Had not undergone any oral surgical procedure,
• Were not leukopenic or thrombocytopenic,
• And had no oral infection such as aphthous ulcer, stomatitis, or gingivitis.

Exclusion criteria

• Mechanical ventilation was initiated more than 24 hours ago,
• Under 18 years of age,
• Had undergone any oral surgical procedure,
• Were leukopenic or thrombocytopenic,
• Or had an oral infection such as aphthous ulcer, stomatitis, or gingivitis.

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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90 participants in 3 patient groups

Chlorhexidine Gluconate Group

Experimental group

Description:

Before Oral Care: The Patient Identification Form was filled out. The Oral Assessment Scale was applied. An oral culture sample was obtained. Procedure: Participants receive oral care using chlorhexidine gluconate solution every 6 hours for 5 days in the neurosurgical intensive care unit.. The Oral Assessment Scale was applied. On the final day (Day 5), an oral culture sample was obtained.

Treatment:

Drug: Chlorhexidine gluconate (CHG)

Sodium Bicarbonate Group

Experimental group

Description:

Before Oral Care: The Patient Identification Form was filled out. The Oral Assessment Scale was applied. An oral culture sample was obtained. Procedure: Participants receive oral care using sodium bicarbonate solution every 6 hours for 5 days in the neurosurgical intensive care unit. The Oral Assessment Scale was applied. On the final day (Day 5), an oral culture sample was obtained.

Treatment:

Drug: Sodium Bicarbonate (NaHCO3)

Apple Cider Vinegar Group

Experimental group

Description:

Before Oral Care: The Patient Identification Form was filled out. The Oral Assessment Scale was applied. An oral culture sample was obtained. Procedure: Participants receive oral care using apple cider vinegar solution every 6 hours for 5 days in the neurosurgical intensive care unit. The Oral Assessment Scale was applied. On the final day (Day 5), an oral culture sample was obtained.

Treatment:

Other: Apple Cider Vinegar